DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control
and Prevention (CDC)
Memorandum
Date: January 7, 2011
From: WHO Collaborating Center for
Research, Training and Eradication of Dracunculiasis
Subject: GUINEA WORM WRAP-UP #202
To: Addressees
“Perseverance and spirit have done wonders in all ages.” George Washington
GHANA IS DONE
Sometimes the sight and sound of bat against ball or gloved
fist against an opponent’s head lets seasoned observers sense
a homerun or knockout has occurred even before the ball
leaves the park or the boxer hits the floor. We feel that way
now about Guinea worm eradication in Ghana. With seven
consecutive months of zero cases reported since May 2010
and fourteen months after reporting its last known
uncontained case in October 2009, Ghana has finally
conquered Guinea worm disease. (Figure 1) This early
conclusion is unprecedented. Up to now the editors of Guinea Worm Wrap-Up have, with good reason,
warned Ghana repeatedly about the perils of over-confidence or premature declarations of success. We
have never before felt as assured about a national milestone of elimination before at least twelve
consecutive months of indigenous cases have passed as we do now. And that this should occur in Ghana
is especially wondrous, given that country’s exceptionally tortuous and delayed arrival at this point in its
campaign. The long hoped-for portents were there with the record-breaking 85% reduction in cases
between 2007 (3,358 cases) and 2008 (501 cases), the 97% reduction in cases between 2009 (242 cases)
and 2010 (8 cases), and the obsessive attention to detecting every case, containing every worm, and
tracing every source that Ghana’s Guinea Worm Eradication Program has manifest recently. A reward
scheme is now operational in all recently endemic districts of Ghana that pays 50 Ghana cedis (~US$36)
for reporting a case if the case is contained at a case containment center.
Over the years, Guinea worm disease has been entwined in Ghana’s history, ethnology, geology,
climatology, economy, traditional beliefs and modern politics. This disease once closed schools in Ghana
by preventing so many young scholars from being able to walk. Soon after the program began, Ghana’s
“stunned” Secretary (minister) for Agriculture wrote the Secretary for Health to plead for help for the
many farmers he had just seen suffering from Guinea worm disease during his visit up country to launch
the annual maize-purchasing season. And a particularly outrageous outbreak struck hundreds of terrified
preschoolers in 2007 less than five weeks before Ghana celebrated its 50th Anniversary of political
independence. But after more than 500,000 cases since its inception; over four million cloth filters, more
than one million pipe filters, 72,000 liters of ABATE®Larvicide; at least nine ministers of health and nine
missed target dates, we are confident that Ghana’s Guinea Worm Eradication Program has finally
achieved the demise of the worm. However, vigilant surveillance is still required until no Guinea worms
remain anywhere. CONGRATULATIONS GHANA; AND STAY ALERT!!
Figure 1
Ghana Guinea Worm Eradication Program
Number of Reported Cases of Dracunculiasis: 2006 - 2010*
1,200
Cases Reported by Year and
% Change in Cases Reported
2006 = 4,134
2007 = 3,358: -14%
2008 = 501: -85%
2009 = 242: -52%
2010* =
8: -97%
1,005
1,000
800
600
622
606
605
478
400
433
403
412
337
293
272
241
293
200
162
Last uncontained
case reported
144
Last indigenous
case reported
110
80
68 70 73
77
39
41
19 29
0
68 74 73
48
30
45 50 52
13 5 8 14 15
28 35 18
7
1 1
3 0 2
2 3
1 1
1 0 0
0 0
0 0
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Number of Cases
732
2006
2007
2008
2009
2010*
*Provisional
Surveillance, Surveillance, Surveillance!
SUDAN: GUINEA WORM “PEACE DIVIDEND” GETTING CLOSER
Results presented at the Fifth Annual Program Review of the Southern Sudan Guinea
Worm Eradication Program (SSGWEP) that was held in Juba on December 8-9, 2010
show continued progress in 2010 towards the goal of interrupting transmission of
Guinea worm disease in Southern Sudan by the end of 2012. Between 2009 and
January - November 2010, the number of cases was reduced by 38%, from 2,733 to a
provisional total of 1,686 (Figure 2), and the number of endemic villages reporting
indigenous cases was reduced by 61% from 584 in 2009 to 226 in 2010. During January-November 2010
a total of 726 villages reported one or more cases of GWD, and 500 of those villages reported only
imported cases. Since 2006 the SSGWEP has reduced the number of cases by 92% and the number of
endemic villages by 93%. Figure 3 shows the geographic distribution of endemic villages during 2009
and 2010.
Seventy-four percent (74%) of the cases reported so far in 2010 were contained, and 30% of all cases
were contained in a case containment center, compared to 8% contained in a case containment center in
2009. The monthly reporting rate and percentages of endemic villages with health education and
complete cloth filter coverage was near 100% for 2009 and 2010, while the percentage of endemic
villages with pipe filters increased from 47% to 60%. ABATE® Larvicide coverage increased from 45%
to 60% and safe water coverage increased from 16% to 22% of endemic villages. The Ministry of Water
Resources and Irrigation (MWRI) and UNICEF completed 85 of 100 new water points targeted for 2010.
These new water points were completed in 69 villages that reported 547 cases of Guinea worm disease in
2009 (20% of all cases that year) and 130 cases in 2010 (8% of 1,686 cases in 2010). MWRI and
UNICEF expect to begin drilling by six contractors in mid-January 2011. Repair of several boreholes in
endemic communities in the Greater Kapoeta focus has languished, however.
Southern Sudan now contains 95% of all cases in the world. 91% of all Southern Sudan’s cases in 2010
occurred in only 6 of Southern Sudan’s 80 counties: Tonj North, East and South in Warrap State, Kapoeta
East and North in Eastern Equatoria State, and Awerial in Lakes State. The same six counties contain
87% of all cases remaining in the world. The Greater Kapoeta focus is an especially complex mix of
transmission in villages, gardens (farming areas), and cattle camps, with frequent migration among the
different sites and resistance to bandaging. It also is the site of earliest transmission in the calendar year
(Figure 4). SSGWEP operations were disrupted by 20 insecurity incidents in 2010, compared to 32 such
incidents in 2009. There is some concern about thousands of displaced persons now returning to highrisk areas, especially in Warrap State.
The Integrated Disease Surveillance and Response (IDSR) system being assisted by the World Health
Organization (WHO) and the United States Agency for International Development (USAID) as the main
means to detect cases in GW-free areas has improved; an average of 57 (71%) of all counties reported in
weeks 37-45 of 2010, but needs to improve even more in order to detect any imported cases of GWD in
GW-free areas quickly. Of Southern Sudan’s 80 counties, 18 still have indigenous transmission of GWD
and 62 are considered GW-free. Still urgently needed is a written Plan of Action for implementation,
supervision, monitoring and evaluation of surveillance in GW-free areas including standardized protocol
and case investigation and cross-notification forms, as well as standard operating procedures for reporting
and investigating rumors. The Recommendations from the Program Review are listed below.
The Review, which was attended by about 100 participants, was opened by the Acting Minister of Health,
Her Excellency Agnes K. Lasuba, and the Minister of Water Resources and Irrigation, His Excellency
Paul Mayoum Akec. Three County Commissioners from Tonj South, Tonj East and Terekeka also
attended, as did representatives from WHO, UNICEF and The Carter Center.
As of December 15, 2010, The Carter Center’s former deputy Resident Technical Advisor, Mr. David
Stobbelaar, replaced the former Resident Technical Advisor, Mr. Alex Jones, who resigned after two
Figure 2
Southern Sudan Guinea Worm Eradication Program
Number of Reported Cases of Dracunculiasis: 2006 - 2010*
1,500
1,400
2007
2008
2009
2010*
1,398
Parameter
2007
2008
2009
2010*
Cases
5,815
3,618
2,733
1,686
50%
49%
78%
74%
1,765
947
584
226
87%
94%
99%
% Containment
1,300
End. Villages
1,200
% Reporting
1,089
Number of cases reported
1,100
70%
*Provisional: January - November
1,001
1,000
900
800
759
783
700
618
615
600
521
503
500
543
536
458
428
413
400
360
289
300
200
208
192
258
221
240
190
159
146
275
254
159
113
32
12
6
35
34
88
47
Jan
Feb
Mar
100
0
160
148
141
95
18
Apr
May
Jun
Month
Jul
Aug
Sept
Oct
75
65
55
36
27
21
14
Nov
Dec
*Provisional
Figure 3
Figure 4
Southern Sudan Guinea Worm Eradication Program
Number of Cases of Dracunculiasis Reported From Three Focal Areas During 2009 AND 2010*
400
Warrab / Western Bahr al Ghazal Focal Area
2009
400
Lakes / Central Equatoria Focal Area
2010*
2009
350
2010*
350
324
250
299
300
Number of cases reported
Number of cases reported
300
2009 =1,257 Cases
Jan-Nov 2009 = 1,280 Cases
Jan-Nov 2010 = 664 Cases
% Change = -48%
% Reporting 2010 = 99%
222
197
200
166
157
150
100
87
86
51
50
0
93
51
6
4
9
2
Jan
Feb
Mar
13
Apr
39
200
150
28
19
Jun
Jul
Aug
84
69
73
Sept
Oct
140
140
149
83
27
27
7
Nov
Dec
31
0
Nov
Dec
51
47
50
0
May
132
100
87
19
250
2009 = 806 Cases
Jan-Nov 2009 = 799 Cases
Jan-Nov 2010 = 270 Cases
% Change =-66%
% Reporting = 97%
6
0
9
1
0
4
Jan
Feb
Mar
Apr
May
62
43
33
Jun
Jul
Aug
Sept
42
40
Oct
24
9
7
Nov
Dec
Eastern Equatoria Focal Area
400
2009
2010*
350
Number of cases reported
300
250
2009 = 675 Cases
Jan-Nov 2009 = 680 Cases
Jan-Nov 2010 = 667 Cases
% Change = -2%
% Reporting = 97%
208
200
142
123
150
136
123
103
109
100
50
40
27
0
2
0
3
Jan
Feb
11
Mar
Apr
May
Jun
Jul
Aug
40
23
Sept
13
9
Oct
* Provisional:January-November
years of intense and heroic efforts. THANK YOU, Alex and welcome to your new position, David! Ms.
Jessica Flannery is the new deputy RTA in Juba. Welcome Jessica!
5th Annual SSGWEP Review Meeting Recommendations
1. The Task Force should meet every month, review the progress and plan for subsequent
months. Start date of February 1, 2011.
2. The Ministry of Water Resources and Irrigation, with the assistance of the SSGWEP,
should write letters to the State Governors of EEQ, Warrap, Lakes States, and the County
Commissioners of Tonj North, Tonj East and Tonj South, Kapoeta East, Kapoeta North
and Aweriel targeting the 84 highest priority EVs as of 2010 for safe water provision.
3. The Technical Advisors/Program Officers should analyze and investigate with the Field
Officers the reasons for non-containment of cases of GWD during 2010 in order to
improve containment rates during 2011.
4. The SSGWEP should consider using “Official Pond Protectors” in special locations such
as where Abate can not be applied, large water sources, 5+ villages, villages with low
filter uptake, and cattle camp populations.
5. The state and county surveillance officers and the SSGWEP at least on a monthly basis
should exchange information on the rumors and confirmed guinea-worm disease cases,
list of priority villages, villages with GW volunteers.
Detect Every Case! Contain Every Worm! Explain Every Source!
ETHIOPIA & MALI: ALMOST THERE
Ethiopia has reported 20 indigenous cases of dracunculiasis in 2010, plus one case imported from
Southern Sudan, compared to 24 indigenous cases reported during 2009, for a reduction of 17%.(Figure
5) Cases were reported in eleven months of 2010 (February – December), compared to six months of
2009 (March-August), which suggests the program did not detect all cases of the disease in 2009. The
line listing of cases in 2010 is given in Table 1. All 20 indigenous cases were reported from 9 villages in
Gog woreda (district) of Gambella Region, including 4 villages that only had cases imported from other
communities in the district. (Figure 6: Map)
With 19 (90%) of the 21 cases contained, compared to 79% (19/24 cases) containment rate in 2009, the
Ethiopian Dracunculiasis Eradication Program (EDEP) appears to have had tighter control measures as
well as better surveillance in 2010. Eighteen of the cases in 2010 were contained in a case containment
center. During 2010 the EDEP conducted active surveillance in all 69 villages of Gog District, and all of
the endemic villages were covered by health education, cloth and pipe filters, and ABATE® Larvicide.
Six of the 9 villages reporting cases had a least one source of safe water. UNICEF plans to help drill five
new borehole wells early in 2011, to cover some or all of the five most vulnerable sites remaining:
Chayanak, Wichini, and Utuyu villages, and the walking paths between Pugnido Refugee Camp (PRC)
and Abawiri village and between PRC and Wichini village. The EDEP held its annual in-country
Program Review at Gambella Town on December 30, 2010, and increased the cash reward for reporting a
case to 1,000 birr (~US$63) effective January 1, 2011.
Figure 5
Ethiopia Dracunculiasis Eradication Program
Number of Reported Cases of Dracunculiasis: 2009 - 2010*
10
2009 = 24 Cases
Containment Rate = 79%
8
2010*
2010* = 20 Cases
Containment Rate = 90%
Reporting Rate 100%
2009
8
7
6
6
5
4
2
2
1
0
0
0
Jan
Feb
2
1
Mar
1
Apr
May
Jun
2
2
1
1
Jul
Aug
2
1
1
1
0
0
0
Sept
Oct
Nov
0
Dec
*provisional
Mali has reported 57 cases of dracunculiasis (45 or 79% contained) in 2010, compared to 186 cases
reported during 2009, for a reduction of 69%. The 57 cases occurred at 13 sites of indigenous
transmission and 8 sites with only imported cases. 53 of the cases were admitted to a case containment
center, and 45 of the 57 cases (79%) were contained in a case containment center. This was the third year
that Mali has used case containment centers. Patients currently receive 2000 CFA (~US$4) per day to
stay at the case containment center, and may also bring a family member (who also receives 2000 CFA
per day) to help with chores at the center. ABATE coverage at the endemic sites was 93% and all
households in endemic sites have cloth filters. Only 6 cases of GWD were reported from Kidal Region
during 2010 (1 from Tessalit and 5 from Kidal Districts), three years after the onset of the outbreak in
Kidal Region in 2007 and from where 266 cases were reported in 2008. Due to insecurity, staff from the
national program was only able to visit the Kidal Region twice in 2010. So far Mali has had 12 known
uncontained cases in 2010.
We note with concern that since 2008 Tominian, Markala, and or Macina Districts of Segou Region
reported cases of GWD: 4 from Tominian, and one each from Markala and Macina in 2008; 1 case from
Tominian in 2009; and 2 cases, again from Tominian in 2010. The annual recurrence of cases in Segou,
presumably originating from Kona Hinberere locality, since 2008 requires attention, as does the uncertain
origin of allegedly indigenous single cases of GWD reported from Mopti and Douentza Districts in 2010.
Mr. Jim Ting, who has been The Carter Center’s resident technical advisor to the Mali GWEP since 2006
has resigned to accept a position with CDC. The former national coordinator of Niger’s GWEP, Mr. Sadi
Moussa, will replace him as of January 2011.
Thank you, Jim and Welcome Sadi!
Table 1
Ethiopia Dracunculiasis Eradication Program - 2010 GWD Case Follow-Up Summary
Region
Zone
Woreda
Kebele
Village of
Detection
Month
Case/ Worm
Number
Age
Date of Guinea worm emergence, and dates patient was monitored for additional Guinea worms
Sex
Jan
Gambella
Agnuak
Gog
Pugnido
Agenga
February
Gambella
Agnuak
Gog
Pugnido
Agenga
March
1.1
14
F
18
M
2.1
YES
M
16/4/2010
25/5/2010
CCC
Release
15, 19, 23
23
11, 21, 25,
31
10,20,26
1, 18, 29
9, 15, 19, 27
18
Often travels
to Abobo. No
evidence of
an additional
worm.
YES
24
No evidence
of an
additional
worm.
Currently in
Abiwiri.
YES
YES
5.1
20
April
6.1
Gambella
Agnuak
Gog
Pugnido
Weretew
SNNPR
Agnuak
Gog
S. Omo Nyangatom
25/4/2010
M
8/5/2010
13/06/2010
CCC
Release
17, 22, 29
19/5/2010
CCC
Release 22,
27, 31
July
7.3
April
8.1
45
M
27/4/2010
11/5/2010
CCC
Release
18, 23, 27
April
9.1
40
F
30/4/2010
15/52010
CCC
Release
18, 23
May
10.1
10.2
10.3
10.4
30
F
June
1, 8, 11, 21,
3, 12, 20, 26
25, 31
10,20,26
1, 10, 18, 29 9, 15, 19, 27
16, 23
13,27
2, 9, 15, 21,
28
2, 8, 13, 23
19
Multiple
worms.
Readmitted
to CCC4/7/2010.
Currently in
CCC.
8, 15, 21, 24,
31
12, 26, 30
4,17
10, 18, 29
9, 15, 19, 27
20
No evidence
of an
additional
worm.
YES
9, 16, 22, 28
7, 13, 30
3,17,24
12, 20, 27
11, 18, 22
18
No evidence
of an
additional
worm.
YES
18
Multiple
worms.
YES
24
No evidence
of an
additional
worm.
Moved to
Dimma
immediately
after
discharge
and plans to
return
September
2010.
NO
Regularl
visits by
Health
Extension
Worker
No evidence
of an
additional
worm.
YES
27/4/2010
7.2
July
Gambella
17/3/2010
July
June
YES
No evidence
of an
additional
worm.
April
Pugnido Chayanak
No evidence
of an
additional
worm.
19
Abiwiri
Gog
20
10, 18, 22
Pugnido
Agnuak
3, 11, 17, 22
11, 19, 26
Gog
Gambella
11, 19, 27
4,17,24
Agnuak
Utuyu
11, 18, 23
12, 26, 30
Gambella
Pugnido
YES
8, 15, 21, 31
60
Gog
No evidence
of an
additional
worm.
18, 23, 27
4.1
Agnuak
25
19/5/2010
CCC
Release
April
Gambella
3, 11, 17
7/4/2010
Utuyu
18
11, 19, 27
F
Pugnido
PRC
Agnuak
9, 16, 18, 24,
7, 12, 20, 26
28, 31
6/4/2010
CCC
Release
11, 18, 23
YES
Gog
Pugnido
2, 11, 16, 24,
30
Had GWD in
2009. No
evidence of
an additional
worm.
Agnuak
Gog
7, 15, 20, 26
22
Gambella
Agnuak
18, 26
1, 9, 15, 19,
27
F
Gambella
2, 4, 21
Case
Contained?
Nov
1
35
7.1
4/3/2010
CCC
Release 19,
23
Dec
Outcomes/
Findings
Oct
10,20,26
3.1
April
14/2/2010
Sept
11, 21
March
6.2
Aug
7, 14, 23
Abiwiri
May
Jul
15, 19, 23
Pugnido
Agenga
Jun
17, 24,
Gog
Pugnido
May
1/4/2010
CCC release
15, 19, 28
Agnuak
Gog
Apr
30/3/2010
Gambella
Agnuak
Mar
8/3/2010
2.2
Gambella
Feb
Total
Number of
Follow-Up
Visits
30
M
10, 17, 28
7/7/2010
14/7/2010
20/5/2010
Pugnido
Wichini
May
11.1
30
M
Aipa
Lorenkach
o
June
1.1
40
F
13/6/2010
16/6/2010
7/5/2010
19/6/2010,
CCC
Release
22, 29
10/6/2010
9/7/2010, 1st 11/8/2010
CCC
CCC
8, 12, 15, 21,
9, 18, 23, 30
Release, 17, 10,15,23,30
Release
26
20, 23, 26,
24/7/2010
31
5, 10, 17, 23,
30
16, 21, 23,
26
10,14,17,27
8, 12, 15, 21,
9, 15, 23, 30
26
Table 1 (cont.)
EDEP-2010 GWD Case Follow-Up Summary Continued
Region
Zone
Woreda
Kebele
Village of
Detection
Month
Case/ Worm
Number
Age
Date of Guinea worm emergence, and dates patient was monitored for additional Guinea worms
Sex
Jan
June
Gambella
Gambella
Agnuak
Agnuak
Gog
Gog
Pugnido
Pugnido
12.1
Wichini
Wichini
34
July
12.2
July
13.1
13.2
13.3
13.4
13.5
60
M
Feb
Mar
Apr
May
Jun
Jul
Aug
17/6/2010
15/7/2010
23/7/2010
CCC
Release 30
16, 21, 23,
26
12/7/2010
15/7/2010
F
22/7/2010
27/7/2010
29/7/2010
Gambella
Agnuak
Gog
Pugnido
Abiwiri
August
14.1
35
F
1/8/2010
Gambella
Agnuak
Gog
Gog
Dipach
Wadmaro
August
15.1
40
F
1/8/2010,
8/26/2010
CCC
Release
16.1
Sept
Oct
8, 12, 15, 21,
10,14,17,27
9, 16, 23, 29
26
7/9/2010
CCC
8, 11, 15, 18, 6, 9, 16, 20,
Release
26, 29
10,11,13,14, 21, 24, 26
16,17,20,23,
24,26,27,29
Gambella
Gambella
Gambella
Gambella
Gambella
Agnuak
Agnuak
Agnuak
Agnuak
Agnuak
Gog
Gog
Gog
Gog
Gog
Pugnido
Pugnido
Thatha
Pugnido
Pugnido
Utuyu
16.2
9,11,15,18,2 8, 12, 16, 24, 7, 10, 17, 25,
3,25
27
27
9/27/2010
October
16.3
October
17.1
Akek
Terbuni
November
PRC
Agnuak
November
PRC
Agnuak
December
18.1
18.2
18.3
19.1
19.2
19.3
20.1
20.2
38
F
9/30/2010
14/10/2010
35
F
Dec
7/9/2010
CCC
Release
September
PRC
Agnuak
Nov
4/10/2010
22/11/2010
Wounds
Healed and
Sent to
Chieng
26, 29
M
10/11/2010
Outcomes/
Case
Findings Contained?
17
Multiple
worms.
Currently
monitoring a
swelling on
his leg.
NO
25
Multiple
worms.
YES
0
No evidence
of an
additional
worm.
YES
16
No evidence
of an
additional
worm.
YES
2
Multiple
worms.
Currently
monitoring a
swelling on
his leg.
YES
No sign of
additional
worm
YES
10/11/2010
CCC
Release
5/11/2010
60
Total
Number of
Follow-Up
Visits
Currently in Multiple
CCC
worms.
YES
Currently in Multiple
CCC
worms.
YES
6/12/2010
23/11/2010
50
F
23/11/2010
3/12/2010
12
M
12/31/2010
Currently in
CCC
No sign of
additional
worm
YES
UPDATE ON GUINEA WORM OUTBREAK IN CHAD
Chad has reported a total of 10 cases of GWD to the World Health Organization in the
outbreak that was discovered during a WHO mission to Chad in July 2010 as part of precertification activities. Chad had not reported any indigenous cases of the disease in over
ten years. Guinea worms emerged in the current cases in April-November 2010 (Table 2).
CDC has confirmed Dracunculus medinensis in 5 of the 7 specimens sent to CDC: 2 in
August (worms extracted during July-August) and 3 in November (worms extracted during JulySeptember); the other 2 worm specimens also received in November had deteriorated and could not be
tested. The cases reside in 7 villages in 5 districts, range in age from 4-60 years old, and are evenly
divided between males and females. None of the cases were contained, and they reportedly contaminated
water sources in 6 villages in 2010. None of the cases has a known history of travel outside of Chad. The
village of Matui, where the first two confirmed cases reportedly drank unsafe water during a funeral in
2009 has not yet reported a single case. The village of Katawa, which is considered the possible source
where three other patients were infected last year, has also not reported a single indigenous case this year.
Chad is known to have had poor surveillance for GWD during its ten years in the pre-certification phase.
This poor surveillance was noted during an external evaluation in February 2001 at the launch of its precertification phase, during a WHO evaluation in 2006, and during an International Certification Team
(ICT) visit in December 2008. The sources of contamination in Chad (foci of transmission) in 2009 are
unknown. So far there is no evidence of local transmission during 2001-2008, either. WHO issued a
written update on this outbreak as of November 19, 2010, and procured excess filter material from
Burkina Faso and ABATE from Nigeria in advance of larger supplies secured by The Carter Center for
delivery to Chad in December 2010. CDC plans to send two epidemiologists to assist in the investigation
of this outbreak from January 24 to February 22, 2011. Given the proximity of these cases in 2010 to the
international border, Cameroon is advised to be especially alert to the possibility of imported cases from
Chad.
PROGRESS TOWARDS ERADICATION
Six countries reported cases of dracunculiasis during 2010, including Niger with 3 cases imported from
Mali, and Chad’s 10 cases from an outbreak, the origin of which remains unknown. Sudan’s December
2010 report is pending. So far, the provisional tally for 2010 stands at 1,785 cases of GWD reported,
1,329 (74%) contained (Table 3 and Figures 6 and 7). The 1,785 cases reported represent a 44% decrease,
compared with 3,171 cases reported during the same period for each country in 2009 (Figure 8).
Table 2
Chad Guinea Worm Eradication Program
Reported Cases of Guinea Worm Disease: 2010*
CDC
Patient Specimen
Number Accession
Number
Village of
Residence
Village Where
Case
Detected
District
Age
Gender
Date of
Detection
Date of
emergence of 1st
Guinea worm
(total worms
emerged)
Date case
confirmed
Travel History:
Date GW
extracted
Contaminated
Water
Contained
Year, Village and District
1**
PDB10-10
Nanguigoto
Nanguigoto
Guelendeng
60
F
April 2010
04 2010
(2 worms)
April 2010
1-Apr-2010
Yes
No
2008:Mitau Village, Guelendeng District;
and Bram Village, Massenia District
2**
PDB10-9
Nanguigoto
Nanguigoto
Guelendeng
27
F
18-Jun-10
18 June 2010
(1 worm)
19-Jun-2010
23-Jun-2010
Yes
No
2008:Mitau Village, Guelendeng District
Matassi
Massenya
27
F
20-Aug-10
24-Aug-2010
(1 worm)
12-Sept-2010
24-Aug-2010
Yes
No
2005 and 2009:Matassi Village, Mandalia
District
3
Matassi
4
PDB10-16
Madjafa and
Abba Limane Guelendeng
Matassi
15
M
24-Aug-10
10-Aug-10
(1 worm)
Sep
2010
(1
worms)
30-Aug-2010
and
Sept 2010
2-Sept-2010
and
Sept 2010
Yes
No
2010:Abba Limane Village, Guelendeng
District
5**
PDB10-17
Abba Limane
since June Madjafa
2010
Dourbali
25
M
Aug-10
24-Aug-2010
(2 worms)
25-Aug-10
16-Sep-2010
Yes
No
2009:Raihoutou Village, Guelendeng
District
6**
PDB10-15
Abourgoui
Abourgui
Dourbali
60
M
2-Sep-10
July-2010
(5 worms)
13-Sept-10
13-Sept-10
Yes
No
1950s ?:Aboukgai Village, Dourbali
District
7**
PDB10-19
Moulkou
Moulkou
Guelendeng
4
F
17-Sep-10
17-Sept-2010
(1 worm)
17-Sept-10
23-Sep-2010
Yes
No
2009:Cigague Village, Bongor District
8
PDB10-18
Kakoua
Kakoua
Sarh
9
M
1-Oct-10
1-Oct-2010
(1 worms)
2-Oct-10
11-Oct-2010
Yes
No
9
??
Sila
Melfi
10
F
1-Oct-10
1-Oct-10
(1 worm)
2-Oct-10
11-Oct-2010
Yes
No
10
??
Sila
Melfi
42
F
15-Sep-10
15-Sept-10
(2worms)
15-Sep-10
22-Spt-10
Yes
No
* Provisional
** Worm specimens obtained from these patients were confirmed to be Dracunculus medinensis by the Centers for Disease Control and Prevention in Atlanta.
Patients 1 and 4 dates (underlined) are puzzling.
PDB10-15, 17, 19 "preserved" in water
PDB10-16 no specimen in container. However there is an photograph of this patient with a GW emerging from his ankle.
PDB10-18 fixed in formalin
Table 3
Number of Cases Contained and Number Reported by Month during 2010* (Countries arranged in descending order of cases in 2009)
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
COUNTRIES
REPORTING CASES
%
JANUARY
5
SUDAN
2
GHANA
/
0
MALI
ETHIOPIA^
/
0
/
0
CHAD
/
0
NIGER^
7
TOTAL*
/
/
/
FEBRUARY
21
6
3
/
/
2
0
/
0
1
/
0
0
/
0
0
0
25
/
/
8
MARCH
78
35
1
/
/
3
0
/
0
2
1
0
/
/
0
0
0
81
/
/
39
APRIL
119
113
1
/
/
1
0
/
0
6
/
2
0
/
0
0
0
126
/
/
116
MAY
144
160
1
/
/
1
1
/
0
1
/
6
0
/
1
0
0
147
/
/
168
JUNE
173
/
190
0
/
1
0
/
1
1
/
2
0
/
0
0
/
0
174
/
194
JULY
273
241
0
0
4
0
1
2
0
1
0
0
278
244
/
/
/
/
/
/
/
AUGUST
226
/
361
0
/
0
6
6
2
/
/
1
0
/
1
0
/
0
234
/
369
SEPTEMBER
118
/
290
0
/
0
13
6
1
/
/
2
0
/
3
0
/
0
132
/
301
OCTOBER
71
/
159
0
/
0
18
19
1
/
/
1
0
/
1
2
/
0
92
/
180
NOVEMBER DECEMBER
27
95
0
0
3
19
2
1
0
1
0
2
32
118
/
/
/
/
/
/
/
1255
/
36
0
0
0
5
1
2
/
/
/
8
0
45
1
19
1
0
/
2
0
1
1
46
/
/
TOTAL*
2
0
1329
2
/
/
/
/
/
/
/
CONT.
1686
74
8
100
57
79
21
90
10
0
3
67
1785
74
% CONTAINED
88
64
70
75
76
71
75
78
73
78
70
50
74
% CONT. OUTSIDE
SUDAN
100
100
100
88
75
33
63
73
67
91
50
50
75
#DIV/0!
#DIV/0!
* provisional
^ Ethiiopia reported and imported case from Southern Sudan in June, and Niger reported three imported cases from Mali ( 2 in October and 1 in November).The origin of cases in Chad is uncertain.
Shaded cells denote months when zero indigenous cases were reported. Numbers indicate how many imported cases were reported and contained that month.
Number of Cases Contained and Number Reported by Month during 2009* (Countries arranged in descending order of cases in 2008)
NUMBER OF CASES CONTAINED / NUMBER OF CASES REPORTED
COUNTRIES
REPORTING CASES
%
JANUARY
SUDAN
GHANA
MALI
ETHIOPIA
NIGERIA
NIGER
TOTAL*
4
40
0
/
0
/
0
/
0
44
/
/
/
/
FEBRUARY
12
12
49
45
0
/
0
0
/
0
0
/
0
0
0
61
57
/
/
/
/
MARCH
39
18
50
50
0
/
0
2
/
0
0
/
0
0
0
91
68
/
/
/
/
APRIL
134
47
27
52
0
/
0
6
/
2
0
/
0
0
1
167
102
/
/
/
/
MAY
277
221
30
28
1
0
2
6
0
0
0
0
310
255
/
/
/
/
/
/
/
JUNE
388
428
18
34
7
1
6
5
0
0
0
0
419
468
/
/
/
/
/
/
/
JULY
434
458
6
19
14
7
2
8
0
0
0
0
456
492
/
/
/
/
/
/
/
AUGUST
452
/
521
1
/
7
34
23
1
2
0
0
0
0
488
553
/
/
/
/
/
SEPTEMBER
240
543
1
1
48
43
0
1
0
0
1
0
290
588
/
/
/
/
/
/
/
OCTOBER
104
275
2
1
23
68
0
0
0
0
0
2
129
346
/
/
/
/
/
/
/
NOVEMBER DECEMBER
39
141
0
3
5
34
0
0
0
0
1
1
45
179
/
/
/
/
/
/
/
11
55
1
0
3
7
0
0
0
0
0
1
15
63
/
/
/
/
/
/
/
TOTAL*
2134
14
225
2
135
3
19
0
0
0
2
0
2515
19
/
/
/
/
/
/
/
2733
78
242
93
186
73
24
79
0
0
5
40
3190
% CONTAINED
77
90
89
65
66
85
82
83
84
72
71
79
79
% CONT. OUTSIDE
SUDAN
89
98
95
97
83
91
69
80
70
66
75
80
83
* provisional
^ Niger reported 5 imported cases: 1 from Ghana and 4 from Mali.
Shaded cells denote months when zero indigenous cases were reported. Numbers indicate how many imported cases were reported and contained that month.
CONT.
79
#DIV/0!
#DIV/0!
Global Number of Reported Cases of Dracunculiasis During
2006 -2010*
Figure 6
5
Parameter
2006
2007
2008
2009
2010*
Cases
25,217
9,585
4,619
3,190
1,785
End. Villages
3,583
2,016
1,019
629
264
9
5
6
4
4
54%
61%
85%
79%
20
11
4
5
4053
4
3541
3
End. Countries
Containment
3020
Exp. Cases
74%
4
* Provisional: January - November
2391
2295
2
1643
1498
1373
1234
1087
1
841 888 797
689
636
629
510
1119
895933
777
710
611
503
351
210221
131134123147
0
553588
468492
346
332
255
226
179
117
102
63 19
40 57 68
369
301
244
180
168194
118
116
46
8 39
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Number of Cases (in thousands)
4716
2006
2007
2008
2009
2010
Figure 7
Distribution by Country of 1,781 Indigenous Cases of Dracunculiasis: 2010*
Number of cases
0
200
400
600
800
1,000
1,200
1,400
1,600
2,000
1,686
Sudan (11)
57
Mali (12)
Ethiopia (12)
1,800
20
* Provisional. Numbers in parenthess denotes number of months for which
reports have been received, i.e. (11) = January - November 2010.
Excludes one case imported into Ethiopia from Southern Sudan in June
2010, and three cases imported into Niger from Mali. The origin of an outbreak of
10 cases reported from Chad remains uncertain.
Ghana (12) 8
Figure 8
Number of Indigenous Cases Reported During the Specified Period in 2009 and 2010*, and Percent
Change in Cases Reported
Country
Indigenous Cases
Reported
% CHANGE 2009 - 2010*
2009
2010*
Ghana (12)
242
8
Mali (12)
186
57
2719
1686
24
20
Sudan (11)
Ethiopia (12)
Chad (12)
Total
All countries, excluding
Sudan
-100%
-50%
0%
-97%
-69%
-38%
-17%
~
10
3171
1781
452
95
* Provisional: excludes cases exported from one country to another
(11) Indicates months for which reports were received, i.e., Jan.-Nov..2010*
-44%
-79%
RECENT DONATIONS FOR GW ERADICATION
The Carter Center is pleased to announce three new pledges received for the Guinea Worm
Eradication Program from the Conrad N. Hilton Foundation, Khalifa Bin Zayed Al Nahyan
Foundation, and the OPEC Fund for International Development (OFID). These generous gifts
will be matched by the Bill & Melinda Gates Foundation on a one-to-one basis as part of the $40
million challenge grant.
The Conrad N. Hilton Foundation has been a partner to The Carter Center since 1991. The new
grant will be used in Ghana and Mali, with residual funding available for Sudan. The Hilton
Foundation seeks to alleviate the suffering of the world’s most disadvantaged and vulnerable
people. Founded in 1944 by hotel entrepreneur and business leader Conrad N. Hilton, the
philanthropic organization currently supports strategic initiatives in five priority areas: providing
safe water, ending chronic homelessness, preventing substance abuse, caring for vulnerable
children, and extending Conrad Hilton’s support for the work of Catholic Sisters.
Established in 2007 by the President of the United Arab Emirates, His Highness Sheikh Khalifa
bin Zayed Al Nahyan, the Khalifa Foundation is a philanthropic organization with a strategic
focus on improving health and education. The Khalifa Foundation supports vocational education
projects as well as initiatives addressing poor nutrition, child protection and care, and access to
safe water in more than 35 countries worldwide.
The OPEC Fund for International Development (OFID) is an intergovernmental development
finance institution, established in 1976 by the then-13 member countries of the Organization of
the Petroleum Exporting Countries (OPEC). OFID promotes cooperation between its member
countries and other developing countries as an expression of south-south solidarity. In
particular, it supports the social and economic advancement of low-income countries.
IMPORTANT DATES IN 2011

January 9: Referendum on Southern Sudan independence

January 17-25: meeting of WHO Executive Board, at WHO headquarters in Geneva (report and
draft resolution on global GWEP)

January 26: Press event in Accra to announce 2010 results of Ghana’s GWEP

February 15-18: Program Review for GW endemic countries and countries in pre-certification
stage, at The Carter Center in Atlanta

February 17: Carter Center Ceremony to honor interruption of GW transmission in Niger and
Nigeria, in Atlanta

May 16-24: World Health Assembly in Geneva (report, resolution, exhibit and meeting on global
GWEP)
DEFINITION OF CASE CONTAINMENT
A case of Guinea worm disease is contained if all of the following conditions are met:
1. The patient is detected before or within 24 hours of worm emergence, and
2. The patient has not entered any water source since the worm emerged, and
3. The village volunteer has properly managed the case, by cleaning and bandaging until the worm
is fully removed, and by giving health education to discourage the patient from contaminating
any water source (if two or more emerging worms are present, the case is not contained until the
last worm is pulled out), and
4. The containment process, including verification that it is a case of Guinea worm disease, is
validated by a supervisor within 7 days of the emergence of the worm.
RECENT PUBLICATIONS
Eberhard ML, Ruiz-Tiben E, Korkor AS, Roy SL, Downs P, 2010. Case report: emergence of
Onchocerca volvulus from skin mimicking Dracunculus medinensis. Am J Trop Med Hyg 83: 13481351.
Hopkins DR, 2010. Progress on neglected disease is most moot if we neglect to count. Nature Medicine
16(2): 1358.
Meyer C, 2010. Der Pracsident und der Wurm. Der Spiegel 50:118-122.
World Health Organization, 2010. Monthly report on dracunculiasis cases, January-September 2010.
Wkly Epidemiol Rec 85:495-496.
OBITUARY
KARL KAPPUS, GUINEA WORM WARRIOR (1938-2010)
We report with great sadness and regret the passing of Dr. Karl Daniel Kappus of Atlanta on
December 11. Dr. Kappus earned his doctoral degree at Ohio State University by conducting research
on mosquitoes, and worked at the Centers for Disease Control and Prevention (CDC) for more than
three decades. During his tenure at CDC and for several years after his retirement, he was a valiant
warrior in the fight to eradicate Guinea worm disease, helping in particular to develop the strategies
for vector control with ABATE®Larvicide, and for case containment. Working in cooperation with
CDC and The Carter Center, he trained Guinea worm fighters in Pakistan, Uganda, Nigeria and
Ghana, and helped develop the technical manual for use of ABATE in Guinea Worm Eradication
Programs. He lived to see the end of Guinea worm disease in all of the countries where he worked,
and almost the completion of the global campaign. We extend our condolences to his family.
Inclusion of information in the Guinea Worm Wrap-Up
does not constitute “publication” of that information.
In memory of BOB KAISER
For information about the GW Wrap-Up, contact the WHO Collaborating Center for Research, Training, and
Eradication of Dracunculiasis, CGH, Centers for Disease Control and Prevention, F-22, 4770 Buford Highway, NE,
Atlanta, GA 30341-3724, U.S.A. FAX: 770-488-7761.
The GW Wrap-Up web location is http://www.cdc.gov/parasites/guineaworm/publications.html
Back issues are also available on the Carter Center web site English and French are located at
http://www.cartercenter.org/news/publications/health/guinea_worm_wrapup_english.html.
http://www.cartercenter.org/news/publications/health/guinea_worm_wrapup_francais.html
_______________________________________________________________________________________
CDC is the WHO Collaborating Center for Research, Training, and Eradication of Dracunculiasis.